How to treat social phobia?

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Psychiatric hospital of Guangzhou brain hospital Jiang Zeyu:Your illness can not simply judge, if it is convenient to the hospital outpatien

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Psychiatric hospital of Guangzhou brain hospital Jiang Zeyu:

Your illness can not simply judge, if it is convenient to the hospital outpatient registration examination, my visits Tingzhen time see my personal homepage. Click here to refer to my article "understanding social phobia".

If social phobia, the treatment includes two parts, part of the drug treatment, the other part of the psychological treatment. A brief introduction is as follows. Specific implementation, there must be a full participation of specialist.

(a) drug treatment

(1) first-line drugs

(1.1) 5 - serotonin reuptake inhibitors (SSRIs) as the initial amount of antidepressant dose, such as Pa Rossi Dean 20mg/ D, 50mg/ D or sertraline clovoxamine 50mg/ D. Because of panic patients SSRIs easy excited, so when the social phobia with panic disorder, the initial dose should be reduced to the dose of 1/ 4 to 1/ 2, after a slow increase.

(1.2) the treatment of social phobia by SSRIs was higher than that of antidepressant. As Pa Rossi Dean is 20 ~ 50mg, d = 200mg/ and sertraline clovoxamine 150mg/ D; the onset time was 2 ~ 4 weeks, all the onset time is 8 ~ 10 weeks; Pa Rossi Dean efficiency is 66%, 53% for sertraline, clovoxamine is 46%.

(1.3) SSRIs in the maintenance treatment after the onset of SSRIs, at least 1 years of maintenance therapy, and in a few months time slowly by drugs, reducing the dose of 10mg paroxetine monthly range, sertraline is 50mg, clovoxamine is 50mg.

(2) second-line drugs

If a SSRIs treatment is not valid, use another SSRIs. Because the SSRIs is not only effective for social phobia, social phobia and comorbid depression, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder and body dysmorphic disorder is effective and less side effects, so don't give up easily. But d (60mg/) may be an exception, because studies have shown that its efficacy and placebo no significant difference.

(3) three line drugs if another SSRIs is invalid, can be replaced by two benzodiazepines (BZD), gabapentin or a new treatment method, if the SSRIs has some curative effect, also can be added with BZD, gabapentin or venlafaxine treatment.

(4) four line three line drugs if drugs are ineffective, can try a monoamine oxidase inhibitor (MAOIs), phenelzine 60 ~ 90mg/ D is the gold standard for the treatment of social phobia, the effective rate of 12 weeks was higher than placebo (69%: 20%), because of the risk of hypertensive crisis therefore, often limit for intractable social phobia. Moclobemide dangers of hypertension crisis is very small, but the efficiency is similar with the placebo (47%: 34%), so it is only as the four line of drug reserve.

(5) other drugs

Ding Luohuan (average dose 45mg/ d) may enhance the efficacy of SSRIs.

(two) psychotherapy

Psychological therapy has been shown to be effective and can reduce the recurrence rate. There are a lot of researches on cognitive behavior therapy (CBT) in psychotherapy, including cognitive therapy, cognitive reconstruction and social skills training. Heimberg cognitive behavioral group therapy (CBGT) is one of the most widely studied.

Patient: description of the disease (time of onset, the main symptoms, hospital etc.): I got 1 social phobia, accompanied the body sweating, for 25 years. Not treated. Want to know how to treat?

 

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